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Computed Tomography–Measured Psoas Density Predicts Outcomes After Enterocutaneous Fistula Repair
Author(s) -
Lo Wilson D.,
Evans David C.,
Yoo Taehwan
Publication year - 2018
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1028
Subject(s) - medicine , interquartile range , hounsfield scale , enterocutaneous fistula , relative risk , surgery , retrospective cohort study , intensive care unit , complication , confidence interval , fistula , computed tomography
Background Low muscle mass and quality are associated with poor surgical outcomes. We evaluated computed tomography (CT)–measured psoas muscle density as a marker of muscle quality and physiologic reserve and hypothesized that it predicts poor outcomes after enterocutaneous fistula repair (ECF). Methods We conducted a retrospective cohort study of patients 18–90 years old with ECF who failed nonoperative management, requiring elective operative repair at The Ohio State University (2005–2016), and who received preoperative abdomen/pelvis CT scan with intravenous contrast within 3 months of the operation. Psoas Hounsfield unit average calculations were measured at the L3 level. One‐year leak rate, mortality (90 days, 1 years, and 3 years), complication risk, length of stay, dependent discharge, and 30‐day readmission were compared with Hounsfield unit average calculation (HUAC). Results One hundred patients met inclusion criteria. Patients were stratified into interquartile ranges based on HUAC. The lowest HUAC interquartile was our low muscle quality (LMQ) cutoff, which was associated with 1‐year leak (relative risk [RR] = 2.10, P < .005), 1‐year mortality (RR = 2.22, P < .04) and 3‐year mortality (RR = 2.13, P < .007), complication risk (RR = 1.54, P < .001), and dependent discharge (RR = 2.50, P < .004) compared to patients without LMQ. Conclusions Psoas muscle density is a significant predictor of poor outcomes in ECF repair. This readily available measure of physiologic reserve can identify patients with ECF who have increased risk and may benefit from additional interventions and recovery time before operative repair.